NEW YORK, July 16, 2025 /PRNewswire/ — A new report from Gimme Credit’s Senior Bond Analyst, Terri Cancelarich highlights growing pressures facing U.S. health insurers amid regulatory scrutiny and funding risks across Medicare Advantage (MA), Medicaid, and ACA exchange programs.
The report, Health Checkup, cites increased medical utilization and concerns over risk upcoding in MA plans, prompting the Centers for Medicare & Medicaid Services (CMS) to significantly ramp up audits and expand its team of medical coders from 40 to 2,000. Leading insurers like UnitedHealthcare and Humana have proposed internal controls to preempt stricter regulations.
Medicaid could see the biggest shake-up, with proposed work requirements, funding cuts, and rollback of ACA expansion potentially pushing 8–10 million people off coverage—though the report sees full implementation of these proposals as unlikely.
ACA exchanges, now covering 21.4 million Americans, face risk if premium subsidies expire in late 2025. Without renewal, premiums could rise 75%, and 3.8 million could lose coverage. The corporate bond research firm expects some form of subsidy continuation.
Insurers are also working to rebuild trust following recent backlash, pledging to streamline prior authorizations and improve patient communication by 2027. These reforms may slightly raise costs but are seen as positive for long-term member satisfaction and regulatory goodwill.
“2025 will be a transitional year for health insurers, especially those heavily exposed to government-funded plans,” the report concludes. “We expect Medicaid to bear the brunt of cuts, while MA and ACA exchanges remain relatively intact.”
Gimme Credit will monitor upcoming Q2 results and adjust credit ratings as needed.
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